Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
권호 표지
DOI QR코드

DOI QR Code

Needs of the elderly with dementia in long-term care facilities: from the perspectives of patients and caregivers

장기요양시설 거주 치매 노인의 욕구: 대상자와 간호제공자의 관점을 중심으로

  • Received : 2017.09.21
  • Accepted : 2018.01.05
  • Published : 2018.01.31
Download PDF
⟨ Previous Next ⟩

Abstract

This study investigated the needs of the elderly with dementia from the perspectives of patients and caregivers in long-term care facilities. A total of 145 older adults with dementia and 62 nurses from 3 geriatric hospitals were enrolled in this study. The cognitive function, behavioral and psychological symptoms, activities of daily living (ADL), and instrumental activities of daily living (IADL) were measured. The mean number of needs reported by the elderly with dementia was 11.94 and those with unmet needs were 2.91 on average. Nurses showed that the mean number of needs and unmet needs of the elderly with dementia was 14.71 and 1.94, respectively. The largest number of older adults with dementia (42.2%) perceived that the needs for daytime activities were unmet. On the other hand, only 24.1% of nurses evaluated that the needs for daytime activities were unmet. The factors influencing the needs of the elderly with dementia were dependency in ADL and IADL. Therefore, caregivers in long-term care facilities need to take the perception of older adults with dementia into consideration when evaluating the met and unmet needs of the elderly with dementia. In addition, sufficient assistance to IADL and ADL would help reduce the needs of people with dementia.

본 연구의 목적은 장기요양시설에 거주하는 치매 노인의 욕구를 대상자와 간호제공자의 관점에서 각각 평가함으로써 치매 노인의 실제적인 욕구를 반영한 중재를 제공하기 위함이다. 본 연구에는 3개의 노인전문병원에서 총 145명의 치매 노인과 62명의 간호사들이 참여하였다. 치매 노인의 충족된 욕구 및 미충족된 욕구는 Camberwell Assessment of Need for the Elderly(CANE) 도구를 이용하여 평가하였다. 치매 노인 대상자의 인지기능, 정신행동상태, 일상생활수행능력(ADL), 도구적 일상생활수행능력(IADL)을 측정하여 총 욕구의 개수와의 상관관계를 파악하였고, 다중회귀분석 방법을 이용하여 욕구에 미치는 영향요인을 파악하였다. 연구결과, 치매 노인이 평가한 평균 욕구의 개수는 11.94개였으며, 평균 미충족 욕구의 개수는 2.91개였다. 반면 간호사들이 평가한 치매 노인의 평균 욕구의 개수는 14.71개였으며, 이중 미충족 욕구는 평균 1.94개였다. 가장 많은 수의 치매 노인들이 미충족 욕구로 인식한 영역은 낮 시간 활동 영역이었다(42.2%, n=61). 반면 간호사들의 경우 24.1%(n=14)만이 이 영역에 대한 욕구가 미충족 되었다고 평가하여 두 집단 사이에 차이가 있음을 나타내었다. 치매 노인의 총 욕구의 수에 유의하게 영향을 미치는 요인은 IADL과 ADL 수준이었다. 따라서 장기요양시설의 간호제공자들은 치매 노인의 충족 및 미충족 욕구 평가시 대상자의 관점을 반영하여 이를 바탕으로 간호의 우선순위를 설정해야 하며, 대상자들의 일상생활 수행에 충분한 도움을 주어야 하겠다. 향후 지역사회 치매 환자 및 보호자를 대상으로 치매 환자의 욕구 평가 연구가 필요하다.

Keywords

References

  1. Seoul National University Hospital. (2008). Nationwide study on the prevalence of dementia in Korean elders. [cited 21 July 2014]. Available From: http://www.prism.go.kr/homepage/researchCommon/retrie veResearchDetailPopup.do?research_id=1351000-200800 002 (accessed Mar. 20, 2017)
  2. Rabins PV, Lyketsos CG, Steele CD. Practical Dementia Care, New York, NY: Oxford University Press, 2006. DOI: https://doi.org/10.1093/med/9780195169782.001.0001
  3. Social Services Inspectorate. Care Management and Assessment Parishioners Guide, HNSO: London, 1991.
  4. G. McWalter, H. Toner, A. Corser, J. Eastwood, M. Marshall, T. Turvey, "Needs and needs assessment: their components and definitions with reference to dementia", Health & Social Care in the Community, vol. 2, no. 4, pp. 213-219, 1994. DOI: http://dx.doi.org/10.1111/j.1365-2524.1994.tb00167.x
  5. T. Akechi, T. Okuyama, C. Endo, R. Sagawa, M. Uchida, T. Nakaguchi, T. Akazawa, H. Yamashita, T. Toyama, T. A. Furukawa, "Patient's perceived need and psychological distress and/or quality of life in ambulatory breast cancer patients in Japan", Psycho-Oncology, vol. 20, no. 5, pp. 497-505, 2011. DOI: http://dx.doi.org/10.1002/pon.1757
  6. A. Kolanowski, M., Litaker, L., Buettner, J. Moeller, P. T. Costa Jr, "A Randomized Clinical Trial of Theory‐ Based Activities for the Behavioral Symptoms of Dementia in Nursing Home Residents", Journal of the American Geriatrics Society, vol. 59, no. 6, pp. 1032-1041, 2011. DOI: http://dx.doi.org/10.1111/j.1532-5415.2011.03449.x
  7. C. J. Schölzel-Dorenbos, E. J. Meeuwsen, M. G. Olde Rikkert, "Integrating unmet needs into dementia health-related quality of life research and care: Introduction of the Hierarchy Model of Needs in Dementia", Aging and Mental Health, vol. 14, no. 1, pp. 113-119, 2010. DOI: http://dx.doi.org/10.1080/13607860903046495
  8. B. S., Black, D., Johnston, P. V., Rabins, A., Morrison, C., Lyketsos, Q. M. Samus, "Unmet needs of community-residing persons with dementia and their informal caregivers: findings from the maximizing independence at home safety", Journal of American Geriatrics Society, vol. 61, pp. 2087-2095, 2013. DOI: http://dx.doi.org/10.1111/jgs.12549
  9. M. A. Cadieux, L. J. Garcia, J. Patrick, "Needs of people with dementia in long-term care: A systematic review", American Journal of Alzheimer's Disease & Other Dementias, vol. 28, no. 8, pp. 723-733, 2013. DOI: https://doi.org/10.1177/1533317513500840
  10. G. A. Hancock, B. Woods, D. Challis, M. Orrell, "The needs of older people with dementia in residential care", International Journal of Geriatric Psychiatry, vol. 21, pp. 43-49, 2006. DOI: http://dx.doi.org/10.1002/gps.1421
  11. M. Orrell, G. Hancock, K. Liyanage, B. Woods, D. Challis, J. Hoe, "The needs of people with dementia in care homes: the perspectives of users, staff and family caregivers", International Psychogeriatrics, vol. 20, pp. 941-951, 2008. DOI: https://doi.org/10.1017/s1041610208007266
  12. S. Zimmerman, W. L. Anderson, S. Brode, D. Jonas, L. Lux, A. S. Beeber, L. C. Watson, M. Viswanathan, K. N. Lohr, P. D. Sloane, "Systematic Review: Effective Characteristics of Nursing Homes and Other Residential Long-Term Care Settings for People with Dementia", Journal of the American Geriatrics Society, vol. 61, no. 8, pp. 1339-1409, 2013. DOI: http://https://doi.org/10.1111/jgs.12372
  13. L. Sury, K. Burns, H. Brodaty, "Moving in: adjustment of people living with dementia going into a nursing home and their families", International Psychogeriatrics, vol. 25, no. 6, pp. 867-876, 2013. DOI: https://doi.org/10.1017/s1041610213000057
  14. D. Edvardsson, B. Winblad, P. O. Sandman, "Person-centered care of people with severe Alzheimer's disease:current status and ways forward", The Lancet Neurology, vol. 7, no. 4, pp. 362-367, 2008. DOI: http://https://doi.org/10.1016/s1474-4422(08)70063-2
  15. L. Nazarko, "Providing high quality dementia care in nursing homes", Nursing and Residential Care, vol. 11, no. 6, pp. 296-300, 2009. DOI: http://dx.doi.org/10.12968/nrec.2009.11.6.42411
  16. A. H. Pattie, C. J. Gilleard, (1979). Manual of the Clifton Assessment Procedures for the Elderly(CAPE). Sevenoaks:Hodder & Stoughton.
  17. F. I. Mahoney, D. W. Barthel, "Functional evaluation: The Barthel Index", Maryland State Medical Journal, vol. 14, pp. 61-65, 1965.
  18. M. F. Folstein, S. E. Folstein, P. R McHugh. "Mini-mental state: A practical method for grading the cognitive state of patients for the clinician", Journal of Psychiatric Research, vol. 12, no. 3, pp. 189-198, 1975. DOI: https://doi.org/10.1016/0022-3956(75)90026-6
  19. J. H. Park, Y. N. Park, H. J. Ko, "Modification of the MMSE for use with the elderly in a non-western society. Part 2: cutoff points and their diagnostic validities", International Journal of Geriatric Psychiatry, vol. 6, pp. 875-882, 1991. DOI: http://dx.doi.org/10.1002/gps.930061208
  20. D. I. Kaufer, J. L. Cummings, P. Ketchel, V. Smith, A. MacMillan, T. Shelley, O. L. Lopez, S. T. DeKosky, "Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory", The Journal of Neuropsychiatry and Clinical Neurosciences, vol. 12, no. 2, pp. 233-239, 2000. DOI: http://dx.doi.org/10.1176/appi.neuropsych.12.2.233
  21. J. H. Park, S. W. Cho, H. Shon, "Reliability of functional status measurements in elderly people", Journal of Korean Neuropsychiatric Association, vol. 34, no. 2, pp. 475-483, 1995.
  22. M. P. Lawton, E. M. Brody, "Assessment of older people: self-maintaining and instrumental activities of daily living", Gerontologist, vol. 9, no. 3, pp. 179-186. 1969. DOI: http://dx.doi.org/10.1093/geront/9.3_part_1.179
  23. C. W. Won, Y. G. Rho, S. Y. Kim, B. R. Cho, Y., S. Lee, "The validity and reliability of Korean Activities of Daily Living(K-ADL) scale", Journal of the Korean Geriatrics Society, vol. 6, pp. 98-106, 2002.
  24. H. G. van der Roest, F. J. Meiland, H. C. Comijs, E. Derksen, A. P. Jansen, H. P. van Hout, C. Jonker, R. M. Droes, "What do community-dwelling people with dementia need? A survey of those who are known to care and welfare services", International Psychogeriatrics, vol. 21, no. 5, pp. 949-996, 2009. DOI: http://dx.doi.org/10.1017/s1041610209990147
  25. H. G. van der Roest, F. J. Meiland, H. P. van Hout, C. Jonker, R. M. Droes, "Validity and reliability of the Dutch version of the Camberwell Assessment of Need for the Elderly in community-dwelling people with dementia", International Psychogeriatrics, vol. 20, no. 6, pp. 1273-1290, 2008. DOI: http://dx.doi.org/10.1017/s1041610208007400
  26. H. Gronstedt, K. Frandin, A. Bergland, J. L. Helbostad, R. Granbo, L. Puggaard, M. Andresen, K. Hellstrom, "Effects of individually tailored physical and daily activities in nursing home residents on activities of daily living, physical performance and physical activity level: a randomized controlled trial", Gerontology, vol. 59, no. 3, pp. 220-229, 2013. DOI: http://dx.doi.org/10.1159/000345416
  27. E. Weening-Dijksterhuis, M. H. de Greef, E. J. Scherder, J. P. Slaets, C. P. van der Schans, "Frail institutionalized older persons: A comprehensive review on physical exercise, physical fitness, activities of daily living, and quality-of-life", American Journal of Physical Medicine & Rehabilitation, vol. 90, no. 2, pp. 156-168, 2011. DOI: http://dx.doi.org/10.1097/phm.0b013e3181f703ef
  28. S.-A. Lee, W.-M. Jeong, Y.-J. Hwang, C.-A. Park, "A preliminary study on the effectiveness of group occupational therapy program for dementia patient in day-care center", Journal of the Korea Academia-Industrial Cooperation Society, vol. 16, no. 3, pp. 2055-2063, 2015. DOI: https://doi.org/10.5762/KAIS.2015.16.3.2055
  29. E. Park, H. Kang, "Needs of early-stage dementia", Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology, vol. 7, no. 1, pp. 647-659, 2017. DOI: https://doi.org/10.14257/AJMAHS.2017.01.81